This project proposes to test, implement, and evaluate a targeted screening program for squamous cell carcinomas of the head and neck in selected Massachusetts cities. The objective is to reduce state-wide mortality rates from these cancers by selective screening of persons at high risk both for the cancers and for late presentation with advanced cancers. The chief risk factors are heavy use of alcohol and tobacco. This is a five-year project involving two phases. In phase I incident cases who are residents of Boston will be interviewed and have their charts reviewed to identify intersections with health care and social services in the 2 years prior to diagnosis. Facilities for screening in Boston will be chosen on the basis of case analysis. In addition the screening intervention, symptomatic history and systematic head and neck exam, will be pilot-tested and finalized. The strategy for full-scale implementation of the screening program will be derived. In phase II 3 groups of cities will be chosen for a quasi-experimental study of the effects of the screening program. Type 1, Boston, will have facilities chosen by case analysis. Type 2 cities will use facilities analogous to Boston's to test the generalizability of the case analysis. Type 3 cities will serve as controls. Screening over 10,000 individuals is anticipated in phase II. Both active and passive follow-up of screenees is planned. Ultimate evaluation of the program's success will be determined by comparison of age-specific mortality rates from squamous cell carcinomas of the head and neck in the 3 types of cities using the population-based state tumor registry. Intermediate outcome evaluation will compare the stage distributions of all incident cases in the 3 types of cities over the project's span.